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General NPI Number Information
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NPI Number | 1083567374
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Entity Type | Organization
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Legal Business Name | GREENCREST LLC
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Dates
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Enumeration Date | 02/17/2026
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Last Update Date | 02/17/2026
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Provider Practice Location Address
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Address Line | 3125 EXEC PKWY STE 120
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City | LEHI
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State | UT
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Zip | 84048-5750
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Country | US
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Telephone | 385-335-5256
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Fax |
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Provider Business Mailing Address
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Address Line | 3125 EXEC PKWY STE 120
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City | LEHI
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State | UT
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Zip | 84048-5750
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | TYLER BROCKBANK
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Credential |
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Telephone | 385-335-5256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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